Serious HIV concern

Dear Drs

Thank you for your useful resource. I will try and keep my story short. I live in Hong Kong.

On 13/12 I met a girl (Indonesian) and we had sex several times. During this process the condom broke. I do not know for how long. I withdrew and put on a new one and continued. To make matters worse I later noticed she was bleeding from what I don't know. To add further worry once the matter was over the girl demanded money. I did not know she was a professional although I suppose I should have guessed.

On 18/12 I noted 6 largish pimples in the 'boxer' on the upper left side and 2 smaller ones down below on the right. I went to the Dr straight away and he diagnosed me with HPV (3 small bumps I hadn't noticed) not herpes (he said it was atypical for herpes) and referred me to a dermatologist. That same day I saw the D (18th), he took one look and diagnosed me with both herpes and HPV, froze the 3 bumps on my penis and proscribed antiviral meds. I was devastated. I've never contracted any STD. My main concern is the HIV risk which seems high. I had a test on the 18th to screen back (other exposures were safe other than that which gave me a mild HPV probably in July) and negative. I realise now what a fool I was and that I should have also used PEP but it's too late. So:

1. On the above facts what do you consider the risks (I'm frightened due to the herpes which has now largely cleared following a full course of antivirals and antibiotics). This was a single exposure however it high risk.

2. I am going to get the DUO HIV test at 28 days and have read it's 100% accurate. if I get it at say 20 days is it possible to say what accuracy that would provide?

I am currently on holiday with my kids and this is destroying what should be quality time with those that should matter most. I can't eat or sleep properly


Thank you.

[Edward W Hook, MD]

Welcome to our Forum.  Just as you heard on the Herpes Community site, I am suspicious that the lesions you noted are not herpes.  Clinical diagnosis, even when made by experts, is wrong about 20-25% of the time and while it is difficult for me to be sure where your lesions were/are located, they sound atypical for herpes.  

Whether this is herpes, HPV or anything else however, it is unlikely that you have acquired HIV from this encounter and unless there is additional information.  I certainly would not have recommended PEP for you.  Please remember, most commercial sex workers, including those in Hong Kong, do not have HIV and even if your partner did, the risk of infection from a single brief unprotected exposure is low- less than 1 infection per 100 sex acts).  there is no known risk for HIV from receipt of oral sex- there are no proven cases in which someone has gotten HIV from receiving oral sex from an infected partner.

As for your specific questions:

1. On the above facts what do you consider the risks (I'm frightened due to the herpes which has now largely cleared following a full course of antivirals and antibiotics). This was a single exposure however it high risk.

See above- I do not agree. This was not a particularly high risk exposure.  

2. I am going to get the DUO HIV test at 28 days and have read it's 100% accurate. if I get it at say 20 days is it possible to say what accuracy that would provide?

I'm sorry, we do not have figures for the accuracy of a DUO test at 20 days- I would expect it to detect between 60- and 75% of recent infections but this is just a guess.

I hope my comments are helpful.  Please don't be worried. EWH

[InAsia101]

there is one small lesion on the top of my penis that the Dr diagnosed as herpes as well.

[InAsia101]

I'm not sure if I was clear. The intercourse was not oral but rather virginal in it's entirety. To be clear we had sex more than once but during the same the condom broke on 1 occasion. The unprotected sex was brief but the overall encounter was not (we spent several hours together). During the remaining period I wore a condom.

My main concern is, assuming I am infected with HSV2 by this individual, the increased risk I would have in contracting HIV. I have read the presence of HSV2 increases the risk of transmission greatly. Whilst I am concerned about the herpes (not so much the HVP as it appears minor and has been treated) HIV transmission is of course my main concern due to the current diagnosed and treatment for herpes infection and my partner's blood presence during sex assuming she was infected.

In terms of the herpes it does look more like public folliculitis to my layman's eye and the GP did did give a different diagnosis to that of the dermatologist who took a look and said, yep that's herpes! Having said that I have been on 2000mg of APO Valacylovir a day since 19 December and 'also' 1,125mg of augmentin for something else and the sores have almost cleared up. The GP said the augmentin would help 'down there' which surprised me. In any event I have been diagnosed but I'll get a HerpesSelect test in 3 months - perhaps this last part is best posted in a new thread - I don't want to abuse your generosity.

Many thanks and best wishes for the new year.

[Edward W Hook, MD]

You were clear.  Sorry if I was not- the ONLY risk for you was your brief unprotected vaginal exposure and that was taken into account in my estimate.

By the way, in re-reading the reply, I see that I said your risk from the single vaginal exposure was 1 in 100.  That was a typo, this risk, IF she was infected (unlikely) was about 1 in 1000 and your HSV does not dramatically change this.  

Hope this helps.  Like you, to me the lesions you describe sounds more like folliculitis than anything else.  Further, with all due respect to your doctors, I am not at all clear why they think augmentin has any role in helping with this. EWH

[InAsia101]

The augmentin was proscribed in reference to another infection but the GP said it may also help with the herpes.

Just one point I sought clarification on above - the presence of blood - does this greatly increase risk assuming it was present during my unprotected exposure?

Many thanks.

[Edward W Hook, MD]

No, I considered the presence of blood in my original answer.

And.... for your information, augmentin has no effect whatsoever on herpes.  EWH

[InAsia101]

One final point I failed to mention. My final question. The girl was under the influence (we both were). I thought she was drunk but perhaps upon reflection it was drug use. I have no evidence for IV drug use but this worries me. How would this change your answer if at all. This will be my last point.